A Study of Pembrolizumab (MK-3475) in Combination With Etoposide/Platinum (Cisplatin or Carboplatin) for Participants With Extensive Stage Small Cell Lung Cancer (MK-3475-604/KEYNOTE-604)
- Conditions
- Small Cell Lung Cancer (SCLC)
- Interventions
- Biological: PembrolizumabDrug: Normal saline solution
- Registration Number
- NCT03066778
- Lead Sponsor
- Merck Sharp & Dohme LLC
- Brief Summary
The purpose of this study is to assess the safety and efficacy of pembrolizumab plus standard of care (SOC) chemotherapy (etoposide/platinum \[EP\]) in participants with newly diagnosed extensive stage small cell lung cancer (ES-SCLC) who have not previously received systemic therapy for this malignancy.
The primary study hypotheses are that pembrolizumab+EP prolongs Progression-free Survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 by blinded independent central review (BICR) and Overall Survival (OS) compared with placebo+EP in adult participants with ES-SCLC. In this study, RECIST 1.1 has been modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ.
With protocol Amendment 07 (03-Oct-2018), the outcome measure of "Change from Baseline at Weeks 12 and 24 in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) Global Health Status/Quality of Life Scale" was replaced with a single time point analysis at Week 18.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 453
- Has a documented new diagnosis of SCLC by histology or cytology from brushing, washing, or needle aspiration of a defined lesion. Participants who do not have histology samples (defined as core or excisional biopsy, or resections) will need to undergo a new biopsy to provide a tissue sample.
- Has extensive-stage disease defined as Stage IV (T any, N any, M 1a/b) by the American Joint Committee on Cancer (AJCC), Seventh Edition
- Has ≥1 lesion that meets the criteria for measurable, as defined by RECIST 1.1, and is appropriate for selection as a target lesion, as determined by local site investigator/radiology assessment
- Has provided archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion not previously irradiated
- Has Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1
- Has a life expectancy of ≥3 months
- Has adequate organ function
- Female and male participants of childbearing potential must be willing to use an adequate method of contraception, starting with the first dose of study treatment through 120 days after the last dose of study treatment and up to 180 days after last dose of chemotherapeutic agents
- Has received prior systemic therapy for the treatment of SCLC
- Is currently participating and receiving study treatment or has participated in a study of an investigational agent and received study treatment or used an investigational device within 4 weeks of the first dose of treatment for another health-related problem
- Is expected to require any other form of antineoplastic therapy for SCLC, including radiation therapy, while on study. (Prophylactic cranial irradiation will be possible for those participants with stable disease or better at the completion of the 4 cycles of chemotherapy with or without pembrolizumab.)
- Has known central nervous system (ie, brain and/or spinal cord) metastases and/or carcinomatous meningitis. Participants with brain metastases may participate only if they satisfy all of the following:
- Has completed treatment (eg, whole brain radiation treatment [WBRT], stereotactic radiosurgery, or equivalent) ≥14 days prior to the first dose of study treatment,
- Has no evidence of new or enlarging brain metastases confirmed by post-treatment repeat brain imaging performed ≥3 weeks after pre-treatment brain imaging, and
- Is neurologically stable without the need for steroids for ≥7 days before first dose of study treatment.
- Has had major surgery within 3 weeks prior to receiving the first dose of study treatment or has not recovered adequately from toxicity and/or complications from an intervention prior to receiving the first dose of study treatment.
- Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis
- Has a known history of interstitial lung disease
- Has a known additional malignancy that is progressing or requires active treatment. Exceptions include early stage cancers (carcinoma in situ or Stage 1) treated with curative intent, basal cell carcinoma of the skin, squamous cell carcinoma of the skin, in situ cervical cancer, or in situ breast cancer that has undergone potentially curative therapy.
- Has active autoimmune disease that has required systemic treatment in the past 2 years. Replacement therapy is not considered a form of systemic treatment.
- Has a known history of, or active, neurologic paraneoplastic syndrome
- Has clinically active diverticulitis, intra-abdominal abscess, gastrointestinal obstruction, and/or abdominal carcinomatosis
- Has a history of a severe hypersensitivity reaction to treatment with another monoclonal antibody
- Is taking chronic systemic steroids (in doses exceeding 10 mg daily of prednisone equivalent) within 7 days prior to the first dose of study treatment
- Has a diagnosis of immunodeficiency or is receiving any form of immunosuppressive therapy within 7 days prior to the first dose of study treatment
- Has received a live vaccine within 30 days prior to the first dose of study treatment
- Has received prior therapy with an anti-programmed cell death protein-1 (anti-PD-1), anti-programmed cell death-ligand 1 (anti-PD-L1), or anti-programmed cell death-ligand 2 (anti-PD-L2) agent or with an agent directed to another co-inhibitory T-cell receptor (i.e., cytotoxic T-lymphocyte-associated protein 4 [CTLA-4], tumor necrosis factor receptor superfamily member 9 [TNFRSF9, OX-40, CD137]) or has previously participated in a Merck pembrolizumab (MK-3475) clinical trial
- Has severe hypersensitivity (Grade ≥3) to pembrolizumab and/or any of its excipients
- Has an active infection requiring systemic therapy
- Has a known history of human immunodeficiency virus (HIV) infection
- Has a known history of Hepatitis B or known active Hepatitis C virus infection
- Has a known history of active TB (Bacillus Tuberculosis)
- Has symptomatic ascites or pleural effusion. A participant who is clinically stable following treatment for these conditions (including therapeutic thoraco- or paracentesis) is eligible.
- Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the study starting with the screening visit through 120 days after the last dose of study treatment through and up to 180 days after last dose of chemotherapeutic agents
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Pembrolizumab+EP Pembrolizumab During each 21-day cycle, participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 PLUS etoposide 100 mg/m\^2 IV on Days 1, 2 and 3 PLUS investigator's choice of platinum therapy (carboplatin titrated to an area under the plasma drug concentration-time curve \[AUC\] 5 IV on Day 1 OR cisplatin 75 mg/m\^2 IV on Day 1). Participants who stop pembrolizumab as a result of obtaining a response of stable disease (SD), partial response (PR), complete response (CR) or those who stop after receiving pembrolizumab for 24 months for reasons other than disease progression or intolerability, are eligible for up to an additional 1 year of treatment after progressive disease if they meet the criteria for retreatment. Placebo+EP Normal saline solution During each 21-day cycle, participants receive placebo (normal saline solution) IV on Day 1 PLUS etoposide 100 mg/m\^2 IV on Days 1, 2 and 3 PLUS investigator's choice of platinum therapy (carboplatin titrated to an AUC 5 IV on Day 1 OR cisplatin 75 mg/m\^2 IV on Day 1). Pembrolizumab+EP Etoposide During each 21-day cycle, participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 PLUS etoposide 100 mg/m\^2 IV on Days 1, 2 and 3 PLUS investigator's choice of platinum therapy (carboplatin titrated to an area under the plasma drug concentration-time curve \[AUC\] 5 IV on Day 1 OR cisplatin 75 mg/m\^2 IV on Day 1). Participants who stop pembrolizumab as a result of obtaining a response of stable disease (SD), partial response (PR), complete response (CR) or those who stop after receiving pembrolizumab for 24 months for reasons other than disease progression or intolerability, are eligible for up to an additional 1 year of treatment after progressive disease if they meet the criteria for retreatment. Pembrolizumab+EP Carboplatin During each 21-day cycle, participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 PLUS etoposide 100 mg/m\^2 IV on Days 1, 2 and 3 PLUS investigator's choice of platinum therapy (carboplatin titrated to an area under the plasma drug concentration-time curve \[AUC\] 5 IV on Day 1 OR cisplatin 75 mg/m\^2 IV on Day 1). Participants who stop pembrolizumab as a result of obtaining a response of stable disease (SD), partial response (PR), complete response (CR) or those who stop after receiving pembrolizumab for 24 months for reasons other than disease progression or intolerability, are eligible for up to an additional 1 year of treatment after progressive disease if they meet the criteria for retreatment. Pembrolizumab+EP Cisplatin During each 21-day cycle, participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 PLUS etoposide 100 mg/m\^2 IV on Days 1, 2 and 3 PLUS investigator's choice of platinum therapy (carboplatin titrated to an area under the plasma drug concentration-time curve \[AUC\] 5 IV on Day 1 OR cisplatin 75 mg/m\^2 IV on Day 1). Participants who stop pembrolizumab as a result of obtaining a response of stable disease (SD), partial response (PR), complete response (CR) or those who stop after receiving pembrolizumab for 24 months for reasons other than disease progression or intolerability, are eligible for up to an additional 1 year of treatment after progressive disease if they meet the criteria for retreatment. Placebo+EP Carboplatin During each 21-day cycle, participants receive placebo (normal saline solution) IV on Day 1 PLUS etoposide 100 mg/m\^2 IV on Days 1, 2 and 3 PLUS investigator's choice of platinum therapy (carboplatin titrated to an AUC 5 IV on Day 1 OR cisplatin 75 mg/m\^2 IV on Day 1). Placebo+EP Cisplatin During each 21-day cycle, participants receive placebo (normal saline solution) IV on Day 1 PLUS etoposide 100 mg/m\^2 IV on Days 1, 2 and 3 PLUS investigator's choice of platinum therapy (carboplatin titrated to an AUC 5 IV on Day 1 OR cisplatin 75 mg/m\^2 IV on Day 1). Placebo+EP Etoposide During each 21-day cycle, participants receive placebo (normal saline solution) IV on Day 1 PLUS etoposide 100 mg/m\^2 IV on Days 1, 2 and 3 PLUS investigator's choice of platinum therapy (carboplatin titrated to an AUC 5 IV on Day 1 OR cisplatin 75 mg/m\^2 IV on Day 1).
- Primary Outcome Measures
Name Time Method Progression-free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR) Up to approximately 30.5 months PFS was defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurred first. PD, as determined by RECIST 1.1, was defined as ≥20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. The appearance of one or more new lesions was also considered PD. For this study, RECIST 1.1 was modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ. The PFS was calculated using the non-parametric Kaplan-Meier method for censored data and presented for the first course of study treatment per protocol.
Overall Survival (OS) Up to approximately 30.5 months OS was defined as the time from randomization to death due to any cause. Participants without documented death at the time of the analysis were censored at the date of the last follow up. The OS was calculated using the non-parametric Kaplan-Meier method for censored data and presented for the first course of study treatment per protocol.
- Secondary Outcome Measures
Name Time Method Change From Baseline at Week 18 in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) Global Health Status/Quality of Life Scale Baseline (prior to first dose of study treatment in Cycle 1 [cycle length = 21 days]) and Week 18 EORTC QLQ-C30 is a questionnaire that rates the overall quality of life in cancer participants. The first 28 questions use a 4-point scale (1=not at all to 4=very much) for evaluating function (physical, role, social, cognitive, emotional), symptoms (diarrhea, fatigue, dyspnea, appetite loss, insomnia, nausea/vomiting, constipation, and pain) and financial difficulties. The last 2 questions use a 7-point scale (1=very poor to 7=excellent) to evaluate overall health and quality of life. Scores are transformed to a range of 0 to 100 using a standard EORTC algorithm. Change from baseline scores were calculated using a constrained longitudinal data analysis (cLDA) model. Negative change from baseline values indicated deterioration in health status or functioning and positive changes indicated improvement. Data are presented for the first course of study treatment per protocol.
Number of Participants Who Experienced an Adverse Event (AE) Up to approximately 30.5 months An adverse event was defined as any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product and which did not necessarily have to have had a causal relationship with this treatment. An adverse event could therefore be any unfavourable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product or protocol-specified procedure, whether or not considered related to the medicinal product or protocol-specified procedure. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition that was temporally associated with the use of the Sponsor's product, was also an adverse event. The number of participants who experienced an AE was reported for each arm according to the treatment received and is presented for the first course of study treatment per protocol.
Change From Baseline at Week 12 in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) Global Health Status/Quality of Life Scale Baseline (prior to first dose of study treatment in Cycle 1 [cycle length = 21 days]) and Week 12 EORTC QLQ-C30 is a questionnaire that rates the overall quality of life in cancer participants. The first 28 questions use a 4-point scale (1=not at all to 4=very much) for evaluating function (physical, role, social, cognitive, emotional), symptoms (diarrhea, fatigue, dyspnea, appetite loss, insomnia, nausea/vomiting, constipation, and pain) and financial difficulties. The last 2 questions use a 7-point scale (1=very poor to 7=excellent) to evaluate overall health and quality of life. Scores were transformed to a range of 0 to 100 using a standard EORTC algorithm. Negative change from baseline values indicated deterioration in health status or functioning and positive changes indicated improvement. Per protocol, data were to be presented for the first course of study treatment.
Change From Baseline at Week 24 in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) Global Health Status/Quality of Life Scale Baseline (prior to first dose of study treatment in Cycle 1 [cycle length = 21 days]) and Week 24 EORTC QLQ-C30 is a questionnaire that rates the overall quality of life in cancer participants. The first 28 questions use a 4-point scale (1=not at all to 4=very much) for evaluating function (physical, role, social, cognitive, emotional), symptoms (diarrhea, fatigue, dyspnea, appetite loss, insomnia, nausea/vomiting, constipation, and pain) and financial difficulties. The last 2 questions use a 7-point scale (1=very poor to 7=excellent) to evaluate overall health and quality of life. Scores were transformed to a range of 0 to 100 using a standard EORTC algorithm. Negative change from baseline values indicated deterioration in health status or functioning and positive changes indicated improvement. Per protocol, data were to be presented for the first course of study treatment.
Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR) Up to approximately 30.5 months ORR was defined as the percentage of participants who achieve a best objective response of complete response (CR) or partial response (PR) per RECIST 1.1. CR was defined as the disappearance of all target lesions. PR was defined as ≥30% decrease in the sum of diameters of target lesions taking as a reference the baseline sum diameters. In this study, RECIST 1.1 was modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ. The ORR was calculated using the Miettinen \& Nurminen method stratified by type of platinum therapy (carboplatin or cisplatin), baseline ECOG performance status (0 or 1), and baseline LDH (≤ or \> upper limit of normal) and presented for the first course of study treatment per protocol.
Number of Participants Discontinuing Study Treatment Due to an Adverse Event (AE) Up to approximately 26 months An adverse event was defined as any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product and which did not necessarily have to have had a causal relationship with this treatment. An adverse event could therefore be any unfavourable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product or protocol-specified procedure, whether or not considered related to the medicinal product or protocol-specified procedure. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition that was temporally associated with the use of the Sponsor's product, was also an adverse event. The number of participants who discontinued due to an AE was reported for each arm according to the treatment received and is presented for the first course of study treatment per protocol.
Number of Participants Experiencing Any Grade 3 to 5 Adverse Events (AE) as Assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events Version 4.03 (CTCAE 4.03) Up to approximately 30.5 months The CTCAE uses Grades 1 through 5 correlating to AE severity criteria. Grade 1=mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2=moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental Activities of Daily Living (ADL). Grade 3=severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care ADL. Grade 4=life-threatening consequences; urgent intervention indicated. Grade 5=death related to AE. The number of participants who experienced any Grade 3 to 5 AE was reported for each arm according to the treatment received and is presented for the first course of study treatment per protocol.
Duration of Response (DOR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR) Up to approximately 30.5 months DOR was defined as the time from first documented evidence of a Complete Response (CR) or Partial Response (PR) per RECIST 1.1 until progressive disease (PD) per RECIST 1.1 or death due to any cause, whichever occurred first. CR was defined as the disappearance of all target lesions. PR was defined as ≥30% decrease in the sum of diameters of target lesions taking as a reference the baseline sum diameters. PD was defined as ≥20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. The appearance of ≥1 new lesions was also considered PD. In this study, RECIST 1.1 was modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ. The DOR was calculated using the product-limit (Kaplan-Meier) method for censored data and is presented for the first course of study treatment per protocol.
Time to True Deterioration (TTD) in the Composite Endpoint of Cough, Chest Pain, and Dyspnea Using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and Lung Cancer Module 13 (QLQ-LC13) Day 1 of Cycles 1-9, Day 1 of every other cycle for Cycles 10-17 and 30 days after last dose of study treatment (Up to approximately 27 months) TTD in patient-reported lung cancer symptoms of cough (QLQ-LC-13 Item 1), chest pain (QLQ-LC-13 Item 10), and dyspnea (QLQ-C30 Item 8) was a composite endpoint defined as the time to first onset of ≥10 point deterioration from baseline in an item confirmed by a second adjacent ≥10 point deterioration. The QLQ-LC13 consists of 13 measures of lung cancer symptoms and side effects from chemotherapy and radiation. It is scored on a 4-point scale (1=none, 2=a little, 3=quite a bit, 4=very much). Scores were transformed to a range of 0 to 100 using a standard algorithm. Higher scores represented increasing symptom severity. TTD was calculated using the product-limit Kaplan-Meier method for censored data and is presented for the first course of study treatment per protocol.
Trial Locations
- Locations (148)
William Osler Health System (Brampton Civic Hospital) ( Site 0161)
🇨🇦Brampton, Ontario, Canada
Weinberg Cancer Institute at Franklin Square ( Site 1210)
🇺🇸Baltimore, Maryland, United States
Massachusetts General Hospital ( Site 1203)
🇺🇸Boston, Massachusetts, United States
National Hospital Organization Shikoku Cancer Center ( Site 0614)
🇯🇵Matsuyama, Ehime, Japan
Hyogo Cancer Center ( Site 0611)
🇯🇵Akashi, Hyogo, Japan
National Cancer Center Hospital East ( Site 0613)
🇯🇵Kashiwa, Chiba, Japan
National Cancer Center ( Site 0904)
🇰🇷Goyang-si, Korea, Republic of
Shizuoka Cancer Center Hospital and Research Institute ( Site 0607)
🇯🇵Sunto-gun, Shizuoka, Japan
National Hospital Organization Yamaguchi Ube Medical Center ( Site 0601)
🇯🇵Ube, Yamaguchi, Japan
Meir Medical Center ( Site 0503)
🇮🇱Kfar Saba, Israel
Chaim Sheba Medical Center. ( Site 0501)
🇮🇱Ramat-Gan, Israel
Niigata Cancer Center Hospital ( Site 0610)
🇯🇵Niigata, Japan
Soroka Medical Center ( Site 0505)
🇮🇱Beer Sheva, Israel
Rabin Medical Center ( Site 0504)
🇮🇱Petah Tikva, Israel
National Hospital Organization Nagoya Medical Center ( Site 0615)
🇯🇵Nagoya, Aichi, Japan
National Hospital Organization Kinki-chuo Chest Medical Center ( Site 0608)
🇯🇵Sakai, Osaka, Japan
Kurume University Hospital ( Site 0609)
🇯🇵Kurume, Fukuoka, Japan
Kanagawa Cancer Center ( Site 0618)
🇯🇵Yokohama, Kanagawa, Japan
Ramban Medical Center - Dept. Hemato. & B. Marrow Transplant ( Site 0502)
🇮🇱Haifa, Israel
Sendai Kousei Hospital ( Site 0602)
🇯🇵Sendai, Miyagi, Japan
Inje University Haeundae Paik Hospital ( Site 0905)
🇰🇷Busan, Korea, Republic of
Complejo Hospitalario Universitario de A Coruna ( Site 0953)
🇪🇸A Coruna, Spain
Hacettepe Universitesi Tip Fakultesi Hastanesi ( Site 1060)
🇹🇷Ankara, Turkey
North Middlesex Hospital ( Site 1151)
🇬🇧London, United Kingdom
Ankara UTF ( Site 1055)
🇹🇷Ankara, Turkey
National Cheng Kung University Hospital ( Site 1004)
🇨🇳Tainan, Taiwan
Medipol Hastanesi ( Site 1066)
🇹🇷Istanbul, Turkey
Maidstone Hospital ( Site 1155)
🇬🇧Maidstone, United Kingdom
Hospital Ciudad de Jaen ( Site 0957)
🇪🇸Jaen, Spain
Trakya Uni. Tip Fakultesi ( Site 1063)
🇹🇷Edirne, Turkey
Istanbul Universitesi Cerrahpasa Tip Fakultesi ( Site 1058)
🇹🇷Istanbul, Turkey
Hospital Universitari Vall d Hebron ( Site 0951)
🇪🇸Barcelona, Spain
Universitaetsspital Zuerich ( Site 1404)
🇨🇭Zuerich, Switzerland
Ege Universitesi Tıp Fakultesi ( Site 1052)
🇹🇷Izmir, Bornova, Turkey
Baskent University Adana Dr. Turgut Noyan EAH ( Site 1057)
🇹🇷Adana, Turkey
Dr. Abdurrahman Yurtaslan Ankara Onkoloji EAH ( Site 1053)
🇹🇷Ankara, Turkey
Medical Park Izmir Hospital ( Site 1051)
🇹🇷Izmir, Turkey
Hospital Universitario Fundacion Jimenez Diaz ( Site 0954)
🇪🇸Madrid, Spain
St James s University Hospital ( Site 1161)
🇬🇧Leeds, United Kingdom
Duke University Medical Center ( Site 1214)
🇺🇸Durham, North Carolina, United States
St John of God ( Site 0006)
🇦🇺Murdoch, Western Australia, Australia
Orszagos Onkologiai Intezet ( Site 0453)
🇭🇺Budapest, Pest, Hungary
St James Hospital ( Site 1452)
🇮🇪Dublin, Ireland
Zala Megyei Szent Rafael Korhaz ( Site 0457)
🇭🇺Zalaegerszeg, Hungary
Veszprem Megyei Tudogyogyintezet ( Site 0454)
🇭🇺Farkasgyepu, Hungary
Mazowiecki Szpital Onkologiczny ( Site 0757)
🇵🇱Wieliszew, Mazowieckie, Poland
Przychodnia Lekarska Komed ( Site 0769)
🇵🇱Konin, Poland
Centrum Onkologii Ziemi Lubelskiej im. sw. Jana z Dukli ( Site 0767)
🇵🇱Lublin, Poland
Orszagos Koranyi TBC es Pulmonologiai Intezet ( Site 0459)
🇭🇺Budapest, Hungary
Jasz Nagykun Szolnok Megyei Hetenyi Geza Korhaz Rendelointezet ( Site 0451)
🇭🇺Szolnok, Hungary
Taipei Veterans General Hospital ( Site 1002)
🇨🇳Taipei, Taiwan
St Vincents University Hospital ( Site 1456)
🇮🇪Dublin, Ireland
SKPP UM im. Karola Marcinkowkiego w Poznaniu ( Site 0766)
🇵🇱Poznan, Poland
Wojewodzki Szpital Zespolony im. L. Rydygiera w Toruniu ( Site 0756)
🇵🇱Torun, Poland
Belgorod Regional Oncology Dispensary ( Site 0804)
🇷🇺Belgorod, Russian Federation
Municipal Clinical Oncology Center ( Site 0802)
🇷🇺Saint Petersburg, Russian Federation
Chi Mei Medical Center Liuying ( Site 1006)
🇨🇳Tainan, Taiwan
Orszagos Koranyi TBC es Pulmonologiai Intezet ( Site 0458)
🇭🇺Budapest, Hungary
Krakowski Szpital Specjalistyczny im. Jana Pawla II ( Site 0768)
🇵🇱Krakow, Poland
N.N. Blokhin NMRCO ( Site 0801)
🇷🇺Moscow, Russian Federation
Wielkopolskie Centrum Pulmonologii i Torakochirurgii ( Site 0762)
🇵🇱Poznan, Poland
Kantonsspital Graubuenden ( Site 1403)
🇨🇭Chur, Switzerland
CHUV Centre Hospitalier Universitaire Vaudois ( Site 1405)
🇨🇭Lausanne, Switzerland
Taichung Veterans General Hospital ( Site 1007)
🇨🇳Taichung, Taiwan
Medeniyet Uni. Goztepe Egitim ve Arast. Hast. ( Site 1064)
🇹🇷Istanbul, Turkey
Kocaeli Universitesi Tip Fakultesi ( Site 1061)
🇹🇷Kocaeli, Turkey
Inonu Universitesi Tip Fakultesi ( Site 1059)
🇹🇷Malatya, Turkey
Hiroshima University Hospital ( Site 0604)
🇯🇵Hiroshima, Japan
The Cancer Institute Hospital of JFCR ( Site 0606)
🇯🇵Tokyo, Japan
National Hospital Organization Kyushu Medical Center ( Site 0617)
🇯🇵Fukuoka, Japan
Osaka International Cancer Institute ( Site 0616)
🇯🇵Osaka, Japan
Baptist Health Medical Group Oncology, LLC ( Site 8000)
🇺🇸Miami, Florida, United States
Rush University Medical Center ( Site 1215)
🇺🇸Chicago, Illinois, United States
North Shore University Health System ( Site 1216)
🇺🇸Evanston, Illinois, United States
Community Hospital ( Site 1207)
🇺🇸Munster, Indiana, United States
Mercy Hospital Saint Louis ( Site 1213)
🇺🇸Saint Louis, Missouri, United States
Minnesota Oncology Hematology, PA ( Site 8001)
🇺🇸Minneapolis, Minnesota, United States
Hattiesburg Clinic ( Site 1205)
🇺🇸Hattiesburg, Mississippi, United States
Comprehensive Cancer Centers of Nevada ( Site 8004)
🇺🇸Henderson, Nevada, United States
Memorial Sloan Kettering Cancer Center- Monmouth ( Site 1225)
🇺🇸Middletown, New Jersey, United States
Memorial Sloan-Kettering Cancer Center At Basking Ridge ( Site 1226)
🇺🇸Basking Ridge, New Jersey, United States
Montefiore Einstein Center for Cancer Care - Main site ( Site 1204)
🇺🇸Bronx, New York, United States
Memorial Sloan Kettering Cancer Center ( Site 1229)
🇺🇸Harrison, New York, United States
Memorial Sloan Kettering Cancer Center ( Site 1211)
🇺🇸New York, New York, United States
Memorial Sloan Kettering Cancer Center - Rockville Centre ( Site 1228)
🇺🇸Rockville Centre, New York, United States
Bon Secours St. Francis Health Sytem ( Site 1212)
🇺🇸Greenville, South Carolina, United States
Texas Oncology-Baylor Charles A. Sammons Cancer Center ( Site 8003)
🇺🇸Dallas, Texas, United States
Blacktown Hospital ( Site 0004)
🇦🇺Blacktown, New South Wales, Australia
Southern Medical Day Care Centre ( Site 0001)
🇦🇺Wollongong, New South Wales, Australia
St Vincents Hospital Melbourne ( Site 0005)
🇦🇺Fitzroy, Australia
Lyell McEwin Hospital ( Site 0002)
🇦🇺Elizabeth Vale, Australia
Cancer Care Manitoba ( Site 0159)
🇨🇦Winnipeg, Manitoba, Canada
Nova Scotia Health Authority ( Site 0157)
🇨🇦Halifax, Nova Scotia, Canada
Kingston Health Sciences Centre ( Site 0155)
🇨🇦Kingston, Ontario, Canada
Sunnybrook Research Institute ( Site 0151)
🇨🇦Toronto, Ontario, Canada
CIUSSS Ouest de l'Ile - St-Mary's Hospital ( Site 0158)
🇨🇦Montreal, Quebec, Canada
CISSS de la Monteregie-Centre ( Site 0152)
🇨🇦Greenfield Park, Quebec, Canada
CISSS-CA Hotel Dieu de Levis ( Site 0154)
🇨🇦Lévis, Quebec, Canada
Instituto Nacional del Cancer ( Site 0207)
🇨🇱Santiago, Region Metropolitana, Chile
Fundacion Arturo Lopez Perez FALP ( Site 0203)
🇨🇱Santiago, Chile
Health and Care Chile ( Site 0202)
🇨🇱Santiago, Chile
St. Jerome Medical Research Inc. ( Site 0160)
🇨🇦St-Jerome, Quebec, Canada
Clinica Universidad Catolica del Maule ( Site 0208)
🇨🇱Talca, Chile
Pontificia Universidad Catolica de Chile ( Site 0206)
🇨🇱Santiago, Chile
CHRU de Lille - Hopital Albert Calmette ( Site 0353)
🇫🇷Lille, France
C.H.R.U. De Limoges ( Site 0358)
🇫🇷Limoges, France
Centre Antoine Lacassagne ( Site 0362)
🇫🇷Nice, France
Hopital Tenon ( Site 0360)
🇫🇷Paris, France
CHU Nantes - Hopital Laennec ( Site 0363)
🇫🇷Nantes, France
Institut de Cancerologie Jean-Godinot ( Site 0351)
🇫🇷Reims, France
CHU de Toulouse - Hopital Larrey ( Site 0354)
🇫🇷Toulouse, France
Evangelische Lungenklinik Berlin ( Site 0403)
🇩🇪Berlin, Germany
Medizinische Fakultaet Carl Gustav Carus der TU Dresden ( Site 0411)
🇩🇪Dresden, Germany
Florence Nightingale Krankenhaus ( Site 0413)
🇩🇪Duesseldorf, Germany
SRH Waldklinikum Gera GmbH ( Site 0405)
🇩🇪Gera, Germany
Universitaetsklinikum Tuebingen ( Site 0404)
🇩🇪Tuebingen, Germany
Orszagos Koranyi TBC es Pulmonologiai Intezet ( Site 0452)
🇭🇺Budapest, Hungary
Philipps-Universitat Marburg ( Site 0414)
🇩🇪Marburg, Germany
Asklepios Klinikum Harburg ( Site 0412)
🇩🇪Hamburg, Germany
Thoraxklinik Heidelberg gGmbH am Universitaetsklinikum Heidelberg ( Site 0401)
🇩🇪Heidelberg, Germany
Petz Aladar Megyei Oktato Korhaz ( Site 0460)
🇭🇺Gyor, Hungary
Fejer Megyei Szent Gyorgy Egyetemi Oktato Korhaz ( Site 0456)
🇭🇺Szekesfehervar, Hungary
Asan Medical Center ( Site 0901)
🇰🇷Seoul, Korea, Republic of
Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie ( Site 0751)
🇵🇱Warszawa, Poland
Dolnoslaskie Centrum Onkologii we Wroclawiu ( Site 0771)
🇵🇱Wroclaw, Poland
SBI of Stavropol region Pyatigorskiy Oncologic dispensary ( Site 0811)
🇷🇺Pyatigorsk, Russian Federation
SBHI Leningrad Regional Clinical Hospital ( Site 0803)
🇷🇺Saint Petersburg, Russian Federation
Hospital Universitario Insular de Gran Canaria ( Site 0952)
🇪🇸Las Palmas de Gran Canaria, Gran Canaria, Spain
Hospital General Universitario Gregorio Maranon ( Site 0958)
🇪🇸Madrid, Spain
Hospital Clinico Universitario de Valencia ( Site 0955)
🇪🇸Valencia, Spain
Kaohsiung Chang Gung Memorial Hospital of the C.G.M.F. ( Site 1005)
🇨🇳Kaohsiung, Taiwan
China Medical University Hospital. ( Site 1003)
🇨🇳Taichung, Taiwan
Birmingham Heartlands Hospital ( Site 1162)
🇬🇧Birmingham, United Kingdom
Mount Vernon Cancer Centre ( Site 1156)
🇬🇧Northwood, United Kingdom
National Taiwan University Hospital ( Site 1001)
🇨🇳Taipei, Taiwan
Beth Israel Deaconess Medical Center ( Site 1206)
🇺🇸Boston, Massachusetts, United States
Memorial Sloan-Kettering Cancer Center at Commack ( Site 1227)
🇺🇸Commack, New York, United States
Dana-Farber Cancer Institute [Boston] ( Site 1201)
🇺🇸Boston, Massachusetts, United States
Wakayama Medical University Hospital ( Site 0612)
🇯🇵Wakayama, Japan
Severance Hospital Yonsei University Health System ( Site 0903)
🇰🇷Seoul, Korea, Republic of
Hospital del Mar ( Site 0956)
🇪🇸Barcelona, Spain
Samsung Medical Center ( Site 0902)
🇰🇷Seoul, Korea, Republic of
Canterbury Regional Cancer & Blood Services ( Site 0701)
🇳🇿Christchurch, New Zealand
University of Michigan ( Site 1217)
🇺🇸Ann Arbor, Michigan, United States
Henry Ford Health System ( Site 1221)
🇺🇸Detroit, Michigan, United States
Tennessee Oncology, PLLC/The Sarah Cannon Research Institute ( Site 1230)
🇺🇸Nashville, Tennessee, United States
Texas Oncology ( Site 8002)
🇺🇸Austin, Texas, United States
Montefiore Medical Center ( Site 1222)
🇺🇸Bronx, New York, United States